1,720,974 research outputs found
Role of transperineal six-core prostate biopsy in patients with prostate-specific antigen level greater than 10 ng/ml and abnormal digital rectal examination findings
No full textOBJECTIVES: To define whether six-core biopsies still have a role in patients presenting with prostate-specific antigen (PSA) levels greater than 10 ng/mL and abnormal digital rectal examination (DRE) findings. Recent studies have suggested that the six-core biopsy is inadequate for the diagnosis of prostate cancer; however, it remains controversial whether an increased number of cores is justified in all patients. METHODS: From June 2002 to February 2005, 122 (18.8%) of 650 patients underwent prostate biopsy because of a PSA level greater than 10 ng/mL and abnormal DRE findings. All patients underwent transperineal ultrasound-guided prostate biopsy in a standardized fashion: a six-core biopsy was performed first, followed by six additional cores during the same session, four in the peripheral and two in the transition zone. RESULTS: The detection rate in patients with a PSA level greater than 10 ng/mL and abnormal DRE findings was 72.1% (88 of 122) and 75.4% (92 of 122) using the 6-core and 12-core biopsy, respectively. One case of tumor was missed by the six-core biopsy among patients with a PSA level greater than 15 ng/mL and abnormal DRE findings. No cases of tumor were missed by six-core biopsy in the group with a PSA level greater than 20 ng/mL and abnormal DRE findings. CONCLUSIONS: Six-core biopsy provided a similar cancer detection rate compared with 12-core biopsy in patients with PSA levels greater than 10 ng/mL and abnormal DRE findings. An initial approach with 6-core biopsy is reasonable in patients with a PSA level greater than 10 ng/mL and abnormal DRE findings and is advocated in those with PSA greater than 20 ng/mL and abnormal DRE findings
Cystoman® and calculi: a good alternative to standard therapies in preventing stone recurrence
No full textTo assess the efficacy and tolerability of d-mannose-containing product (Cystoman(A (R))) in preventing recurrence in patients who underwent surgical treatment for infection related urinary stones. From January 2011 to February 2013 we have enrolled all consecutive patients affected by staghorn calculi and recurrent urinary tract infections (UTIs). All patients recommended for surgery were scheduled for percutaneous nephrolithotomy. The study agent was administered daily for 5 months after surgical procedure. At baseline and 5-month follow-up all patients underwent abdominal Computed Tomography (CT) scan and they also completed Medical Outcomes Study short-form, 36-item questionnaire (SF-36). They performed urine and urine culture monthly. The primary endpoints were the assessment of the efficacy with regard to infection-related urinary stone recurrence and the tolerability of Cystoman(A (R)). The secondary endpoint was the evaluation of quality-of-life symptoms. During the study period, a total of 27 patients were included in the study. The data from 25 patients were analyzable. Seventeen patients (68 %) did not report UTIs during follow-up. Eight patients (32 %) remained infected and the average number of UTIs was 2.6 +/- A 1.6 in 5 months. At 5-month follow-up 17 (68 %) patients were free from stones recurrence; in 8 (32 %) cases CT scan revealed stone recurrence with an average stone diameter of 1.1 +/- A 0.4 cm. In nonrecurring patients, 2 (11.7 %) reported an average of 1.5 +/- A 0.7 UTIs episodes; in recurring patients, 6 (75 %) showed 3 +/- A 1.67 of UTIs episodes. Statistically significant differences were seen in the occurrence of UTIs episodes were detected between nonrecurring stone patients and recurring patients (p < 0.05). Moreover, statistically significant changes were detected in SF-36 scores from baseline to month 5 in the categories of physical functioning and energy/fatigue (p < 0.05). Cystoman(A (R)) is effective in preventing infection-related urinary stones
Role of risk factors for erectile dysfunction in patients undergoing transurethral resection of the prostate: early impact on sexual function
No full textIntroduction. Transurethral resection of the prostate (TURP) has been long debated as a possible cause of erectile dysfunction (ED). We investigated the role of common risk factors for ED in patients aged 60 to 70 undergoing TURP. Factors related to the treatment were also considered. Materials and methods. Ninety patients underwent TURP for benign prostate hyperplasia (BPH) from June 2002 to February 2003. Fourty-two of them, sexually active aged 60 to 70, were administered preoperatively and 3-month postoperatively the International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF-5) questionnaires. A complete assessment of risk factors for ED was performed in the preoperative setting (treated hypertension, diabetes, cigarette smoking, hypercolesterolemy, cardiovascular disease). HEF score was related to age, comorbidities, operative time, resected tissue weight, retrograde ejaculation, IPSS score. Results. Nine (21.4%) patients reported worsened IIEF-5 score after TURP, and 33 (78.6%) unchanged/improved score. Cardiovascular disease was present in 56% of patients with worsened IIEF-5 score and in 12% of patients with improved/unchanged IIEF-5 score; it was the only factor that correlated significantly in the regression model. Conclusion. In general, most patients report a stable sexual function after TURP. Patients with known cardiovascular disease undergoing TURP had an increased risk of sexual impairment after this procedure
Is retrograde intrarenal surgery for the treatment of renal stones with diameters exceeding 2 cm still a hazard?
No full textMajor kidney stones have traditionally been treated with percutaneous nephrolithotomy. However, retrograde intrarenal surgery (RIRS), which until a few years ago was considered inappropriate for this purpose, is becoming a viable, attractive alternative. The aim of the current study was to assess the efficacy and safety of RIRS combined with holmium laser lithotripsy for the treatment of stones > 2 cm in diameter in a large series of patients, reporting complications according to the Clavien-Dindo classification.We reviewed demographic and stone characteristics, intraoperative and postoperative outcomes, and complications
Single-session supine bilateral percutaneous nephrolithotomy
No full textOBJECTIVE:
To evaluate the effectiveness and safety of supine bilateral percutaneous nephrolithotomy (BPCNL) performed in the same session in patients affected with bilateral renal calculi.
METHODS:
We retrospectively identified patients with bilateral renal stones with diameters >2 cm for each side, who had been treated with supine BPCNL in the same session, from November 2006 to April 2014. We reviewed demographic and stone characteristics, intraoperative and perioperative outcomes, and complications related to the procedure adopted. The stone size was calculated by measuring the maximum stone diameter by computed tomography scan. Stone-free rate was defined as clinically insignificant when residual fragments of ≤2 mm were detected by computed tomography scan.
RESULTS:
Twenty-five patients were included in the study; the mean age was 51.9 ± 11.4 years; the mean maximum stone diameter per renal unit was 3.1 ± 0.8 cm. Statistical significant differences in creatinine serum levels were detected at day 1 postoperatively compared with the baseline (P <.0001) values that became insignificant at 1 week and 1 month postoperatively (P >.05). The primary stone-free rate was 80%; ancillary procedures were performed in 3 of 25 patients (12%). Grade I complications occurred in 3 patients (12%), grade II in 4 patients (16%), and grade IIIA in 1 patient (4%).
CONCLUSION:
Supine BPCNL performed in the same session is a safe and effective procedure in patients affected with bilateral renal calculi. On the other hand, it is still a very challenging operation, and consequently, it should be performed only by experienced surgeons in a tertiary center
Is retrograde intrarenal surgery for the treatment of renal stones with diameters exceeding 2 cm still a hazard?
No full textMajor kidney stones have traditionally been treated with percutaneous nephrolithotomy. However, retrograde intrarenal surgery (RIRS), which until a few years ago was considered inappropriate for this purpose, is becoming a viable, attractive alternative. The aim of the current study was to assess the efficacy and safety of RIRS combined with holmium laser lithotripsy for the treatment of stones > 2 cm in diameter in a large series of patients, reporting complications according to the Clavien-Dindo classification.We reviewed demographic and stone characteristics, intraoperative and postoperative outcomes, and complications
Early surgical repair of penile fracture: our experience
No full textOBJECTIVE:
Fracture of the penis is a relatively rare condition, defined as the rupture of the tumescent corpora cavernosa. The fracture is quite easily recognized, whereas its management remains controversial. Our experience regarding the early treatment of penile fractures is herein reported.
MATERIALS AND METHODS:
In a 7-year period (1997-2004) 10 patients aged 23 to 42 years, presented with a penile fracture, occurred during coitus. All patients were admitted to the hospital 1 to 10 hours after injury. Diagnosis was made on clinical examination. Six patients referred a snapping sound at the time of injury. Common clinical features included sudden penile pain, detumescence and penile deviation. All patients showed penile haematoma; 3 had scrotal and perineal haematoma as well. None of the patients had urethral bleeding.
RESULTS:
all patients were surgically treated; at the time of surgery unilateral albuginea rupture was found in all cases. With a mean follow-up of 37 months (range 1-78) all cases were able to achieve an adequate erection. No complications, such as deformations, penile plaque, urethral fistula or erectile dysfunction were reported.
CONCLUSION:
Immediate surgical repair in case of penile fracture is recommended in order to obtain better functional outcome and to avoid potential complications
Role of risk factors for erectile dysfunction in patients undergoing transurethral resection of the prostate: early impact on sexual function.
No full textINTRODUCTION:
Transurethral resection of the prostate (TURP) has been long debated as a possible cause of erectile dysfunction (ED). We investigated the role of common risk factors for ED in patients aged 60 to 70 undergoing TURP Factors related to the treatment were also considered.
MATERIALS AND METHODS:
Ninety patients underwent TURP for benign prostate hyperplasia (BPH) from June 2002 to February 2003. Fourty-two of them, sexually active aged 60 to 70, were administered preoperatively and 3-month postoperatively the International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF-5) questionnaires. A complete assessment of risk factors for ED was performed in the preoperative setting (treated hypertension, diabetes, cigarette smoking, hypercolesterolemy, cardiovascular disease). IIEF score was related to age, comorbidities, operative time, resected tissue weight, retrograde ejaculation, IPSS score.
RESULTS:
Nine (21.4%) patients reported worsened IIEF-5 score after TURP, and 33 (78.6%) unchanged/improved score. Cardiovascular disease was present in 56% of patients with worsened IIEF-5 score and in 12% of patients with improved/unchanged IIEF-5 score; it was the only factor that correlated significantly in the regression model.
CONCLUSION:
In general, most patients report a stable sexual function after TURP. Patients with known cardiovascular disease undergoing TURP had an increased risk of sexual impairment after this procedure
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